Prevalence, Awareness, Treatment and

Control of Hypertension in the Malaysian

Adult Population: Results from the National
Health and Morbidity Survey 1996
T O Lim, Z Morad, Hypertension Study Group
Clinical Research
Centre
Kuala Lumpur
Hospital
Jalan Pahang 50586
Kuala Lumpur
Malaysia
T O Lim, FRCP
Consultant
Nephrologist
Department of
Nephrology
Kuala Lumpur
Hospital
Z Morad, FRCP
Senior Consultant
Nephrologist
Hypertension
Study Group:
Rozita H Hussein
Maimunah A. Hamid
L M Ding
Ismail Merican
Rushdi Ramly
Ismail Samad
Mohd A Kamaluddin
Jenaron Jelip
Norazmi Abdullah
Jamaluddin A Majid
Tong C Tiew
Sondi Sararaks
Correspondence to:
Dr T O Lim
Tel: (60) 3 298 4882
Fax: (60) 3 291 6514
Email: limto@
crc.gov.my
ABSTRACT
We determined the prevalence of hypertension
and the level of awareness, treatment and
control of hypertension among Malaysian adults
in a population based cross-sectional survey.
Twenty-one thousand and three hundred ninety-
one adults aged 30 or older in all 13 states of
Malaysia in 1996 were sampled using a stratified
two-stage cluster sampling design. Thirty-three
percent of adults had hypertension with a higher
percentage among women. Among hypertensives,
33% were aware of their hypertension, 23% were
currently on treatment and a mere 6% had controlled
hypertension. There was practically no difference
in mean BP between treated and untreated
hypertensives. Concerted public health effort is
urgently required to improve the detection, treatment
and control of hypertension in Malaysia.
Keywords: awareness, blood pressure, control,
detection, hypertension, prevalence
Singapore Med J 2004 Vol 45(1):20-27
INTRODUCTION
Hypertension is an important risk factor for cardio-
vascular disease
(1)
. It is also common. Large population
surveys in many countries
(2,3)
showed its prevalence
varied from one to over 30 percent. A similar high
prevalence was found in a previous national survey
in 1986 (unpublished data) as well as in smaller
surveys
(4,5)
in Malaysia. Hypertension is treatable.
Many clinical trials have confirmed that the risk of
cardiovascular disease is decreased by treatment
(6-8)
.
Concerted public health effort is required to detect,
treat and control hypertension in the community,
as shown by the experiences of many countries
(9-11)
.
In the United States (US) over the last two decades,
the National High Blood Pressure Education
Program of the US has been remarkably successful
in increasing detection, treatment and control of
hypertension in the US population
(12)
. The concomitant
decline in cardiovascular mortality in the US is due
in part to this progress in hypertension detection and
control
(12)
. Malaysia on the other hand is experiencing a
rising incidence of cardiovascular disease. Cardiovascular
disease has emerged as the principal cause of mortality
and hypertension is a prevalent cardiovascular risk
factor in our population
(4,5)
. Further, hypertensives often
remain undetected in the community until they present
with cardiovascular complications
(13)
. Of those detected
to have hypertension, their blood pressure often
remained uncontrolled because they failed to comply
with or dropped out of treatment
(13,14)
, or that their
treatment was simply inadequate
(15)
.
We report here findings from the National Health and
Morbidity Survey in 1996 on the prevalence of
hypertension and current status of its awareness, treatment
and control in Malaysian adults.
METHODS
Sampling design and sample
The National Health and Morbidity Survey (NHMS)
was a multi purpose survey designed to describe
the health status, health related behaviour and
health services utilisation for a representative sample
of the population of Malaysia. An up-to-date and
representative sampling frame for this population was
provided by the frame used for the annual Labour Force
survey conducted by the Department of Statistics
(16)
.
The sampling frame was stratified by state and urban/
rural residence. A stratified two-stage cluster sampling
design with self-weighting sample was used to draw
a sample of 17,995 private dwellings. However, only
13,025 (87%) dwellings were contactable or responded.
All residents of sampled dwellings were included
yielding a sample size of 59,903 individuals. For
NHMS component on blood pressure, 23,007 individuals
aged 30 or older were eligible for inclusion. Twenty-
one thousand and three hundred ninety-one (93%) of
them agreed to have their blood pressure measurements
taken or had evaluable responses. Tables I and II
show the composition of the sample.
Interview and blood pressure measurement
During a home visit, the first hour was devoted to
completing a questionnaire administered by an
Singapore Med J 2004 Vol 45(1) : 20-27 O r i g i n a l A r t i c l e
Singapore Med J 2004 Vol 45(1) : 21
interviewer. Either a Malay or an English language version
of the questionnaire was used depending on the
respondents choice. The questionnaire included the
following hypertension related items:
1. Are you known to have high blood pressure?
2. Have you ever been told by a doctor or other health
personnel that you had high blood pressure?
3. Have you ever been on medication for treatment
of high blood pressure?
4. Are you still taking the medication now?
At the end of the interview, respondents blood
pressure (BP) was measured by a trained nurse. The
procedure was explained and verbal permission obtained
from the respondent prior to the examination. Blood
pressure was measured with the respondent in the
sitting position and his/her arm supported at the
same level as his heart. One of two calibrated
electronic devices (Visomat OZ 30 or OZ 2) was
used to measure blood pressure according to the
manufacturers guidelines. Visomat (OZ 30 was used
for patients with arm size 22-32 cm and Visomat
(OZ 2 for obese patients with arm size more than
32 cm. The cuff was placed on the respondents
right arm 2-3 cm above the antecubital fossa. Two
BP measurements were taken with an interval of
three minutes apart. Respondents were informed
of their BP measurements. All nurses attended
centralised training on standardised protocol for
BP measurement. During the field survey, supervisors
conduct weekly checks on compliance with the BP
measurement protocol.
Table II. Sample size by age, sex and ethnicity in the survey.
Malay Chinese Indian Other indigenous
Men, age in years
30-34 821 433 130 322
35-39 799 420 155 278
40-44 705 422 120 233
45-49 592 406 82 145
50-54 420 304 49 155
55-59 399 243 39 91
60-64 282 195 36 101
65-69 212 150 31 55
>=70 273 173 37 102
Women, age in years
30-34 1,002 556 165 433
35-39 971 543 172 343
40-44 854 532 124 210
45-49 599 421 101 199
50-54 453 316 46 123
55-59 400 264 57 112
60-64 325 217 56 105
65-69 221 161 29 72
>=70 329 222 38 115
Table I. Characteristics of respondents compared with total
population of Malaysia aged 20 or older in 1996.
% respondents % Malaysia population
(unweighted) aged 30 or older
n=21391 n=7.84 million
No. (%) %
Sex
Male 10,003 (47%) 50%
Female 11,388 (53%) 50%
Age
30-34 4,253 (20%) 21%
35-39 3,944 (18%) 19%
40-44 3,344 (16%) 16%
45-49 2,638 (12%) 12%
50-54 1,935 (9%) 9%
55-59 1,650 (8%) 7%
60-64 1,360 (6%) 6%
65-69 951 (4%) 4%
>=70 1,316 (6%) 6%
Ethnic
Malay 9,656 (45%) 43%
Chinese 5,978 (28%) 31%
Indian 1,467 (7%) 8%
Other indigenous 3,194 (15%) 9%
Others 1,096 (5%) 10%
The decision to use electronic devices instead of
the mercury sphygmomanometer was based on the
assumption that the electronic device ought to be more
robust. Survey field work can be difficult especially
in outlying parts of the country. A previous national
health survey in 1986 had encountered problems
with mercury leaking rendering the device unusable or
measurements unreliable. Method comparison study
between measurements taken with Visomat and
those taken with a mercury sphygmomanometer
simultaneously was carried out in a clinic patient
population. The intra-class correlation coefficient
between measurements obtained by the two methods
was 0.89 and 0.58 for systolic and diastolic BP
respectively. Overall, systolic BP measurement taken
with the Visomat was 3% lower than that of the
mercury sphygmomanometer. For diastolic BP, it was
6% lower. The 95% limits of agreement was 83%-
114% and 72%-123% for systolic and diastolic BP
respectively. The agreement was judged satisfactory
for survey use.
Definitions
The mean of the two BP measurements was used for
analysis unless only one was available. Hypertension
was defined as a mean systolic blood pressure (SBP)
>140 mmHg, mean diastolic blood pressure (DBP)
>90 mmHg or on current treatment for hypertension
with medications
(9)
. Blood pressure levels were further
categorised as optimal, normal, high normal, stages 1,
2, 3 and 4 hypertension according to the classification
system recommended by the Joint National Committee
on Detection, Evaluation and Treatment of High Blood
Pressure
(9)
. Awareness of hypertension was defined
as any prior knowledge or diagnosis or treatment of
hypertension. Treatment of hypertension refers to
treatment with medications only. Control of hypertension
was defined as current treatment with medication
that is associated with SBP<140 mmHg and DBP
<90 mmHg
(2)
.
Statistical methods
Prevalence estimates and standard errors were calculated
by a method appropriate to the complex sampling
design
(17,18)
.The sampling weights were adjusted for
household non-response using adjustment cells formed
by state and urban/rural residence. Post stratification
(19)
was used to adjust the weighted sample totals to known
population totals for age, gender and ethnicity based
on 1996 census population projection. Prevalence
estimates were standardised by the direct method to the
age distribution of the 1996 adult Malaysian population.
STATA
(20)
software package was used for analysis.
RESULTS
Prevalence
Thirty-three percent or an estimated 2.6 million
Malaysian adults aged 30 or older had hypertension
(Table III). Women had a higher prevalence of
hypertension than men. Malay and other indigenous
women had the highest crude and age-adjusted
prevalence of hypertension while Chinese and Indian
women had the lowest prevalence. Table IV shows the
age-sex-ethnic specific prevalence estimates. Malay
women had a higher prevalence of hypertension than
all other sex-ethnic groups throughout the entire age
range. The typical pattern in age-sex specific prevalence
of younger men having a higher prevalence than younger
women and the reverse for older men and women
was observed only in the Chinese and Indian.
Mean blood pressures
Table V shows the age adjusted mean blood pressure
(BP) values by gender and ethnicity. Malay and other
Table III. Prevalence of hypertension in Malaysian adult population.
Prevalence Age adjusted* prevalence Estimated population
Ethnicity sex n % (SE) % (SE) (SE)
All both 21,391 32.9 (0.5) 32.9 (0.4) 2,577,044 (56200)
men 10,003 31.9 (0.6) 32.1 (0.5) 1,260,209 (33598)
women 11,388 33.9 (0.6) 33.5 (0.5) 1,316,834 (31264)
Malay both 9,656 33.5 (0.6) 33.5 (0.5) 1,138,790 (34917)
men 4,502 29.9 (0.8) 30.0 (0.7) 496,390 (18062)
women 5,154 37.1 (0.8) 36.9 (0.7) 642,400 (20792)
Chinese both 5,978 33.1 (0.8) 31.1 (0.6) 791,090 (32277)
men 2,746 35.2 (1.1) 34.0 (1.0) 420,028 (18848)
women 3,232 30.9 (1.0) 28.2 (0.8) 371,062 (17080)
Indian both 1,467 30.8 (1.3) 31.7 (1.3) 186,257 (14206)
men 679 34.9 (1.8) 35.5 (1.9) 103,965 (8597)
women 788 26.9 (1.7) 27.9 (1.5) 82,292 (7156)
Other indigenous both 3,194 34.3 (1.0) 34.8 (0.9) 237,413 (12338)
men 1,482 32.2 (1.3) 32.8 (1.3) 112,073 (6268)
women 1,712 36.4 (1.3) 36.8 (1.2) 125,340 (6983)
* Age-adjusted to the 1996 Malaysian population.
Singapore Med J 2004 Vol 45(1) : 22
indigenous women had the highest mean systolic BP
(SBP), Chinese and Indian men had the highest diastolic
BP (DBP) while Chinese and Indian women had the
lowest DBP as well as SBP. The tendency of Malay
and other indigenous women to have systematically
higher SBP than all other sex-ethnic groups is further
illustrated in Figs. 1 to 4. In all groups, mean SBP rose
with increasing age but DBP tended to decline beyond
the age 50-55. Younger women had lower SBP than men
but the rise in mean SBP with age was steeper for
women than men such that eventually the mean curves
of the two sexes cross. The cross occurred at the young
age of 35-40 in Malay and other indigenous women.
As a result, they had higher mean SBP than their
Chinese and Indian counterparts throughout the
entire age range as shown in Figs. 5 and 6.
Table IV. Age-sex-ethnic specific prevalence of hypertension.
Prevalence Estimated population
Ethnicity sex Age group, y n % (SE) (SE)
Malay men 30-39 1,620 17.5 (1.0) 116,974 (8265)
40-49 1,297 27.2 (1.4) 127,119 (7803)
50-59 818 44.6 (2.0) 122,958 (6697)
60-69 494 50.1 (2.5) 81,074 (4769)
>=70 273 54.4 (3.4) 48,265 (3520)
Malay women 30-39 1,973 19.1 (1.0) 133,540 (7588)
40-49 1,453 35.3 (1.4) 166,949 (8280)
50-59 853 54.0 (1.9) 150,308 (7135)
60-69 546 64.1 (2.3) 115,253 (5626)
>=70 329 73.6 (2.7) 76,350 (4176)
Chinese men 30-39 853 19.6 (1.6) 81,102 (7467)
40-49 828 33.4 (1.8) 118,526 (7837)
50-59 547 45.4 (2.3) 104,905 (6561)
60-69 345 58.2 (2.9) 72,617 (4489)
>=70 173 63.3 (4.4) 42,877 (4665)
Chinese women 30-39 1,099 9.4 (1.0) 39,296 (4301)
40-49 953 24.3 (1.5) 82,075 (5748)
50-59 580 49.4 (2.3) 103,187 (6489)
60-69 378 58.1 (2.7) 78,032 (4952)
>=70 222 67.0 (3.8) 68,471 (5850)
Indian men 30-39 285 20.7 (2.5) 25,544 (3434)
40-49 202 36.1 (3.4) 31,807 (3483)
50-59 88 51.5 (6.0) 22,397 (3636)
60-69 67 60.2 (5.9) 16,850 (2029)
>=70 37 48.8 (8.5) 7,366 (1596)
Indian women 30-39 337 9.5 (1.7) 12,041 (2022)
40-49 225 25.5 (3.1) 22,736 (3061)
50-59 103 42.9 (4.8) 19,744 (2720)
60-69 85 61.7 (5.5) 17,782 (2126)
>=70 38 68.0 (7.9) 9,990 (1344)
Other indigenous men 30-39 600 19.3 (1.8) 28,898 (2868)
40-49 378 32.1 (2.6) 28,843 (2606)
50-59 246 44.8 (3.5) 25,512 (2185)
60-69 156 52.6 (4.0) 18,300 (1661)
>=70 102 62.3 (4.8) 10,521 (1048)
Other indigenous women 30-39 776 19.0 (1.5) 27,761 (2437)
40-49 409 41.0 (2.6) 35,109 (2568)
50-59 235 50.5 (3.4) 28,558 (2230)
60-69 177 59.3 (4.1) 21,408 (1822)
>=70 115 62.8 (4.6) 12,504 (1086)
Singapore Med J 2004 Vol 45(1) : 23
Table V. Age adjusted* mean systolic (SBP) and diastolic (DBP) blood pressure (mmHg) for all adults, normotensives,
treated hypertensives and untreated hypertensives.
All adults Normotensives Treated hypertensives Untreated hypertensives
SBP (SE) DBP (SE) SBP (SE) DBP (SE) SBP (SE) DBP (SE) SBP (SE) DBP (SE)
All 129 (0.1) 79 (0.0) 119 (0.0) 74 (0.0) 147 (1.4) 90 (0.7) 149 (0.1) 91 (0.1)
men 130 (0.1) 80 (0.0) 120 (0.1) 75 (0.0) 147 (3.1) 92 (1.9) 148 (0.2) 91 (0.1)
women 129 (0.1) 78 (0.0) 117 (0.1) 72 (0.0) 147 (2.5) 89 (1.1) 150 (0.2) 90 (0.1)
Malay 130 (0.1) 79 (0.1) 119 (0.1) 73 (0.0) 149 (3.1) 91 (1.7) 149 (0.2) 91 (0.1)
men 129 (0.2) 79 (0.1) 120 (0.1) 74 (0.1) 148 (7.7) 92 (3.6) 148 (0.5) 91 (0.3)
women 131 (0.3) 79 (0.1) 119 (0.2) 73 (0.1) 149 (5.2) 91 (3.1) 150 (0.4) 91 (0.3)
Chinese 127 (0.2) 79 (0.1) 118 (0.1) 74 (0.1) 145 (6.1) 90 (3.4) 147 (0.4) 91 (0.2)
men 129 (0.4) 81 (0.1) 120 (0.3) 75 (0.1) 144 (5.1) 90 (5.3) 146 (0.6) 92 (0.4)
women 125 (0.3) 77 (0.1) 116 (0.2) 72 (0.1) 145 (22.7) 89 (9.2) 149 (1.0) 90 (0.7)
Indian 127 (0.9) 79 (0.3) 117 (0.5) 74 (0.3) 148 (15.5) 93 (9.0) 147 (1.8) 93 (0.8)
men 129 (2.0) 82 (0.6) 119 (1.0) 76 (0.5) 148 (22.6) 93(14.6) 148 (3.6) 94 (1.1)
women 124 (1.3) 77 (0.7) 115 (1.1) 72 (0.8) 145 (59.3) 92 (9.8) 144 (4.1) 91 (2.1)
Other indigenous 132 (0.4) 79 (0.1) 120 (0.2) 73 (0.1) 147 (5.6) 88 (2.8) 153 (0.7) 90 (0.5)
men 131 (0.8) 80 (0.3) 121 (0.4) 74 (0.3) 146 (17.9) 88(32.7) 152 (1.6) 91 (0.9)
women 132 (0.9) 78 (0.3) 119 (0.4) 73 (0.2) 148 (8.6) 87 (2.4) 153 (1.4) 90 (1.1)
* Age-adjusted to the 1996 Malaysian population.
Overall and in each ethnic group, normotensive
men had a higher mean SBP and DBP than
women. However, among treated and untreated
hypertensives the reverse is true with women having
a higher mean SBP than men, except in Indians.
Mean DBP in treated and untreated hypertensives
remained higher for men than women. There was
practically no difference at all in both mean SBP and
DBP between treated and untreated hypertensives
in all groups. Only in other indigenous ethnic group
was some semblance of a difference in mean BP observed
between treated and untreated hypertensives.
Awareness, treatment and control of hypertension
Table VI shows the percentage of hypertensives who
were aware, ever treated, currently on treatment and
controlled, and the percentage of treated hypertensives
who were controlled. Among hypertensives, a third
was aware of their hypertension status, 31% had ever
been treated but only 23% currently remained on anti-
hypertensive treatment. Only 6% of hypertensives
had BP less than 140/90 (controlled hypertension).
Women were more aware of their hypertension status
than men in all ethnic-age groups. They were also
more likely to have been treated and to remain on
treatment for hypertension.
Among hypertensives currently on treatment,
overall only 26% achieved BP control. Men had
better BP control than women. Except in Indian and
other indigenous men, BP control worsened with
increasing age.
DISCUSSION
There are major limitations with the design of this
survey. We therefore advise caution in its interpretation.
Firstly, prevalence of hypertension was estimated
based on two measurements taken on a single occasion
only. The diagnostic criteria recommended by Joint
National Committee 12 required BP measurements
at two or more subsequent visits after an initial screen.
It is clearly difficult to use such criteria to diagnose
hypertension in large population surveys. Hence,
the prevalence of hypertension in this survey may
have been overestimated and the percentage of
treated hypertensives who were controlled may be
underestimated
(21)
. Secondly, BP was measured by
Visomat in this survey and its measurements of
both systolic and diastolic BP were systematically
lower than those obtained by the conventional mercury
sphygmomanometer. Thus the results (prevalence
and mean BP) would have been higher than those
reported here had mercury sphygmomanometer
been used in the survey. Caution should therefore be
observed in comparing results with those from other
national surveys.
These results are the first description of the
prevalence and control of hypertension in Malaysia.
Clearly, we are looking at an extremely grave situation.
The prevalence rates found here are among the highest
reported in the literature. Malay and other indigenous
women bore a disproportionate share of the burden, and
they also have more severe hypertension. Prevalence
rates however are uniformly high across all ethnic,
Singapore Med J 2004 Vol 45(1) : 24
Table VI. Percentage of hypertensives who were aware, ever treated, currently on treatment* and controlled,
and percentage of treated hypertensives who were controlled.
Hypertensives Currently
treated
hypertensives
Aware Ever Currently Con- Con-
treated treated* trolled** trolled***
Ethnicity sex Age group, y n % (SE) % (SE) % (SE) % (SE) % (SE)
All both all 7225 33 (0.7) 31 (0.7) 23 (0.6) 6 (0.4) 26 (1.3)
men all 3296 29 (0.9) 27 (0.9) 21 (0.8) 6 (0.5) 28 (1.9)
women all 3929 37 (0.9) 35 (0.9) 25 (0.8) 6 (0.5) 25 (1.9)
Malay both all 3346 31 (1.0) 29 (0.9) 19 (0.8) 4 (0.4) 23 (1.9)
Malay men all 1403 27 (1.3) 25 (1.3) 17 (1.1) 4 (0.6) 25 (3.0)
30-49 633 22 (2.0) 21 (1.9) 13 (1.5) 4 (0.8) 31 (5.1)
50-64 513 33 (2.3) 31 (2.3) 22 (2.1) 5 (1.1) 22 (4.3)
>65 257 26 (3.0) 25 (3.0) 18 (2.6) 3 (1.0) 18 (5.6)
Malay women all 1943 34 (1.3) 31 (1.2) 20 (1.0) 5 (0.5) 22 (2.3)
30-49 899 30 (1.7) 26 (1.6) 15 (1.4) 4 (0.7) 29 (4.1)
50-64 660 41 (2.1) 39 (2.1) 28 (2.0) 6 (1.0) 21 (3.3)
>65 384 32 (2.6) 30 (2.6) 19 (2.3) 2 (0.9) 13 (4.3)
Chinese both all 2021 36 (1.3) 34 (1.2) 29 (1.1) 7 (0.7) 26 (2.1)
Chinese men all 1013 32 (1.7) 29 (1.6) 25 (1.5) 7 (0.9) 29 (3.0)
30-49 454 22 (2.1) 19 (2.0) 15 (1.8) 5 (1.0) 34 (5.7)
50-64 355 42 (3.0) 39 (3.0) 34 (2.9) 11 (1.8) 31 (4.7)
>65 204 38 (3.7) 35 (3.4) 32 (3.3) 6 (1.9) 18 (5.6)
Chinese women all 1008 41 (1.8) 39 (1.8) 34 (1.7) 8 (1.0) 23 (2.8)
30-49 351 32 (2.9) 30 (2.9) 24 (2.8) 8 (1.8) 34 (6.4)
50-64 408 49 (2.7) 47 (2.7) 41 (2.7) 10 (1.7) 23 (3.8)
>65 249 40 (3.3) 39 (3.4) 35 (3.2) 5 (1.5) 14 (4.2)
Indian both all 449 36 (2.4) 34 (2.3) 28 (2.3) 9 (1.4) 32 (4.5)
Indian men all 235 35 (3.3) 33 (3.3) 26 (2.9) 9 (1.8) 34 (6.3)
30-49 133 30 (4.5) 28 (4.4) 20 (4.1) 7 (2.3) 34 (9.4)
50-64 66 42 (7.2) 41 (7.1) 34 (6.7) 13 (4.3) 37(10.6)
>65 36 38 (8.7) 38 (8.7) 32 (8.3) 9 (4.5) 28(13.1)
Indian women all 214 37 (3.5) 36 (3.5) 31 (3.6) 9 (2.2) 29 (6.3)
30-49 93 23 (4.1) 21 (3.9) 19 (3.9) 5 (2.1) 23(10.2)
50-64 74 53 (6.3) 53 (6.3) 45 (6.8) 15 (4.9) 33 (9.4)
>65 47 37 (7.0) 35 (7.0) 28 (6.8) 7 (3.8) 26(12.0)
Other indigenous both all 1112 40 (1.9) 37 (1.9) 24 (1.5) 8 (0.9) 32 (3.1)
Other indigenous men all 491 35 (2.6) 32 (2.6) 22 (2.2) 7 (1.2) 34 (4.8)
30-49 235 29 (3.3) 25 (3.2) 17 (2.7) 5 (1.4) 29 (7.5)
50-64 159 43 (4.3) 41 (4.3) 29 (3.9) 10 (2.6) 33 (7.3)
>65 97 36 (5.4) 36 (5.4) 23 (4.2) 11 (3.4) 47(11.9)
Other indigenous women all 621 44 (2.3) 42 (2.3) 26 (1.9) 8 (1.1) 30 (3.7)
30-49 320 43 (3.0) 40 (3.0) 22 (2.5) 8 (1.7) 35 (6.2)
50-64 180 50 (3.9) 49 (3.9) 34 (3.5) 10 (2.2) 29 (5.7)
>65 121 38 (4.5) 34 (4.3) 21 (3.7) 3 (1.5) 16 (7.0)
* Treatment refers to treatment with anti-hypertensive medication.
** Controlled refers to proportion of hypertensives with SBP<140mmHg and DBP<90 mmHg
*** Controlled refers to proportion of hypertensives on anti-hypertensive medication with SBP<140mmHg and DBP<90 mmHg
Singapore Med J 2004 Vol 45(1) : 25
sex and age groups. Even young Malaysian adults have
unusually high prevalence as well as severe hypertension.
While Malaysia no doubt has a serious problem
with hypertension, its detection and treatment is less
than satisfactory as shown in this survey. The survey
found low awareness, low treatment, and poor
control rates across all groups. Overall, only a third of
hypertensives were aware of their hypertension, a
quarter on treatment and a mere 6% of hypertensives
had blood pressure less than 140/90 (controlled
hypertension). The results are considerably poorer
than those found in recent studies assessing the
effectiveness of hypertension control in different
populations
(9-11,22,23)
. In the 1960s to 1970s, the pattern
110
80
100
M
e
a
n

s
y
s
t
o
l
i
c

a
n
d

d
i
a
s
t
o
l
i
c

B
P
,
m
m
H
g
120
130
140
70
Age group, years
30-39 40-49 50-59 60-69 >70
90
150
160
Men
Women
Men
Women
Fig. 1 Mean systolic and diastolic BP for Malay.
110
80
100
M
e
a
n

s
y
s
t
o
l
i
c

a
n
d

d
i
a
s
t
o
l
i
c

B
P
,
m
m
H
g
120
130
140
70
Age group, years
30-39 40-49 50-59 60-69 >70
90
150
Men
Women
Men
Women
Fig. 2 Mean systolic and diastolic BP for Chinese.
110
80
100
M
e
a
n

s
y
s
t
o
l
i
c

a
n
d

d
i
a
s
t
o
l
i
c

B
P
,
m
m
H
g
120
130
140
70
Age group, years
30-39 40-49 50-59 60-69 >70
90
150
Men
Women
Men
Women
Fig. 3 Mean systolic and diastolic BP for Indian.
115
85
105
M
e
a
n

s
y
s
t
o
l
i
c

a
n
d

d
i
a
s
t
o
l
i
c

B
P
,
m
m
H
g
125
135
145
75
Age group, years
30-39 40-49 50-59 60-69 >70
95
155
Men
Women
Men
Women
Fig. 4 Mean systolic and diastolic BP for other indigenous ethnic group.
110
80
100
M
e
a
n

s
y
s
t
o
l
i
c

a
n
d

d
i
a
s
t
o
l
i
c

B
P
,
m
m
H
g
120
130
140
70
Age group, years
30-39 40-49 50-59 60-69 >70
90
150
Malay
Chinese
India
Other indigenous
Malay
Chinese
India
Other indigenous
Fig. 5 Mean systolic and diastolic BP for men.
110
80
100
M
e
a
n

s
y
s
t
o
l
i
c

a
n
d

d
i
a
s
t
o
l
i
c

B
P
,
m
m
H
g
120
130
140
70
Age group, years
30-39 40-49 50-59 60-69 >70
90
150
Malay
Chinese
India
Other indigenous
Malay
Chinese
India
Other indigenous
160
Fig. 6 Mean systolic and diastolic BP for women.
of detection, treatment and control of hypertension
followed the so-called rule of halves
(24,25)
. Since then,
considerable progress has taken place in many
countries. In a recent review of 24 studies
(26)
, the
authors concluded that in industralised countries,
the rule of halves is no longer valid. Unfortunately,
in Malaysia, the rule of halves does not even come
close to describing the situation. Worse yet, this must
be the only survey on BP control in the community that
found practically no difference in mean blood pressure
between treated and untreated hypertensives. In
contrast, US survey
(2)
had found 9/5 mmHg reduction in
mean BP on treatment overall and the difference found
in a Belgian survey
(9)
was 12/13 mmHg.
Singapore Med J 2004 Vol 45(1) : 26
In conclusion, hypertension is highly prevalent
and severe in Malaysia, and its care grossly inadequate.
The situation is grave. Concerted public health effort
is urgently required to improve the detection, treatment
and control of hypertension in Malaysia.
ACKNOWLEDGEMENT
This work was supported by an IRPA Grant (No.
06-05-01-0060) from the Ministry of Science and
Technology, Malaysia.
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